Healthcare Provider Details

I. General information

NPI: 1821030602
Provider Name (Legal Business Name): HOME OXYGEN SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S CHESTNUT ST
KIMBALL NE
69145-1256
US

IV. Provider business mailing address

129 S CHESTNUT ST
KIMBALL NE
69145-1256
US

V. Phone/Fax

Practice location:
  • Phone: 308-235-2900
  • Fax: 308-235-2901
Mailing address:
  • Phone: 308-235-2900
  • Fax: 308-235-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2896
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number2896
License Number StateNE

VIII. Authorized Official

Name: MICHAEL BEMIS
Title or Position: OWNER
Credential:
Phone: 308-235-2900